Ohio Republicans continue their ill-conceived war on sex education, women’s rights and health care for the poor

In the early 1960s, Roe v. Wade had
yet to legalize abortion, Medicaid didn’t exist and educating teenagers
on issues related to women’s health and sex was still considered taboo.
Progressives often argue that society has made great strides on these
issues since that time. But looking at the budget proposal passed by the
Republican-controlled Ohio House in a 61-35 vote on April 18, there
seems to be a strong reluctance by conservatives in power to accept the
scientific and social progress made in the past few decades.

If the Ohio House budget bill is approved
by the Republican-controlled Ohio Senate and signed by Republican Gov.
John Kasich in the next two months, Ohio would forgo the federally
funded Medicaid expansion and defund Planned Parenthood, while funding
crisis pregnancy centers (CPCs) that focus on anti-abortion,
abstinence-only education.

But the bill that made it through the
Ohio House is actually more moderate than the bill that made it through
the Ohio House Finance and Appropriations Committee on April 16. Before
it was amended through a final round of votes in the Ohio House, the
committee-backed bill actually banned comprehensive sex education in
Ohio, touting fears of “gateway sexual activity.” That ban prompted a
harsh response from pro-choice groups.

Kellie Copeland, executive director of
NARAL Pro-Choice Ohio, noted in a statement that the proposal seemed
like a throwback to social and educational policies from decades ago.

“Today the Ohio House Finance Committee
voted to send our state back to the 1950s,” it read. “The Ohio House is
doing everything they can to restrict access to reproductive health care
and medically accurate information that help Ohioans live healthy
lives.”

The committee-backed bill also flat-out
rejected the Medicaid expansion, while the final Ohio House bill asks
for a waiver from the federal government that would give Ohio more time
to mull over a Medicaid expansion and could lead to a revamp of the
state-backed health care program and ensure health insurance coverage
for 456,000 low-income Ohioans.

Still, even the revised budget bill has
upset Democrats, women’s health advocates, educators and hospitals,
which collectively support the Medicaid expansion and funding for
Planned Parenthood and oppose funding for CPCs.

Surprisingly, Kasich actually joined
opponents of the budget bill through his support for a Medicaid
expansion. The Republican governor was the one who proposed accepting
the Medicaid expansion earlier in the year, and he’s stuck by his
support.

“We are pleased that the House backed
away from its initial position and has listened to the governor and
many, many others who have clearly demonstrated the advantages to
businesses, Ohio’s economic recovery and the health of our state of
providing health care to low-income, working Ohioans,” wrote Kasich
spokesperson Rob Nichols in an email to CityBeat. “The process
continues, and the governor is totally committed to extending health
coverage to people who are battling mental illness and addiction, 26,000
veterans and other Ohioans for whom health care is a ladder up and out
of poverty. We look forward to continuing our work with the House and
Senate on this issue and to advancing the rest of our Medicaid and
health-system reforms, which have already improved care and saved $2
billion.”

But it’s so far unclear where Kasich
stands on the other provisions in the bill. When asked about defunding
Planned Parenthood and funding for CPCs, Nichols wrote, “We don’t
comment on every provision in the House budget. There is a process
currently at work, we’re talking to the House and Senate about a number
of provisions, but we don’t do our negotiations through the media.”

Without Kasich, opponents of the budget
bill are left helpless as Republican legislators, who answer to very
conservative gerrymandered districts, jam social issues into a budget
that was initially dubbed “Jobs Budget 2.0” by Kasich and his
supporters, leaving Planned Parenthood and Medicaid in the balance.

No more planning

In what Democrats have labeled a
distraction from creating jobs, Republicans included a measure that
would effectively defund Planned Parenthood by redirecting federal money
elsewhere. The measure continues years of Republican attacks on Planned
Parenthood and other family planning services, which legislators have
criticized for providing abortion services.

But supporters of Planned Parenthood
emphasize that the organization provides much more than abortion
services, and no public funding is used for abortions. Instead, all
abortions are paid for with private donations, and the public funding
Planned Parenthood receives goes to other medical services, including
breast exams, prenatal care, family planning and sexually transmitted
infection (STI) treatment.

Some legislators and supporters say the
measure is not about abortions; they argue they’re just trying to open
up funding for providers that aren’t Planned Parenthood. But at public
hearings over the issue on April 12, Stephanie Kight, president and CEO
of Planned Parenthood of Greater Ohio, pointed out those funds are
already open to different providers. They just happen to lose to Planned
Parenthood in the competitive distribution process because distribution
officials deem Planned Parenthood’s services superior.

Still, Kight did not back down when she
was asked by Republican State Rep. Ron Maag why Planned Parenthood
doesn’t shut down its abortion services if they endanger the “good work”
Planned Parenthood does elsewhere. Kight responded by saying she
believes Planned Parenthood’s abortion services are “good work,”
prompting Maag to cease further questioning.

A separate section of the budget bill
also redirects federal funding to CPCs, which act as the anti-abortion,
abstinence-only alternative to comprehensive family planning services
like Planned Parenthood. At the budget committee hearings over the
issue, Denise Leipold of Right to Life of Northeast Ohio praised CPCs
for promoting chastity and abstinence.

A study released by NARAL Pro-Choice Ohio
found CPCs routinely mislead patients by instilling them with fears
about false links between abortion and mental health problems, breast
cancer and infertility. In what NARAL Pro-Choice Ohio labeled an
“undercover investigation,” the organization found 47 percent of CPCs
gave misleading information about abortions and mental health problems,
and 48 percent gave false information about abortions, breast cancer and
infertility.

Leipold told CityBeat abortion is a major factor behind her organization’s support for the Ohio House budget bill.

“Our mission is to support the right to
life from conception to natural death,” Leipold says. “Abortion happens
to be a big problem right now because in the past 40 years it’s become
part of the culture.”

Copeland of NARAL Pro-Choice Ohio says
the state should heed health care experts, not social conservatives who
are trying to push their own social agenda.

“They’re trying to impose their morals on
you,” Copeland says. “These are not health care experts. These are not
people who are trying to find real solutions for the problems that real
people face. These are people who want to impose their personal views,
their personal morality on you.”

More funding for comprehensive family
services could save the state money. When looking at three ways to
prevent unintended pregnancies for a 2012 study, the Brookings Center on
Children and Families found the most cost-effective policy was to
increase funding for family planning services through the Medicaid
program. In other words, if governments increased spending on family
planning services, they would eventually save money by preventing costly
pregnancies and STI treatment.

For Ashley Hernandez, a 25-year-old
Cincinnati resident and self-proclaimed “second-generation Planned
Parenthood patient,” the Planned Parenthood cuts would have a personal
impact that goes back to her mother, who began using Planned Parenthood
in the 1970s when she found out she was pregnant. Hernandez says her mom
went to Planned Parenthood to get health care she otherwise had no
access to because she was low-income and lacked health insurance.

Hernandez says she has also used Planned
Parenthood since she began using birth control. She says she appreciates
that the option has always been there, even when she didn’t have access
to health insurance.

“Whether I have health insurance or not, I
receive the same quality of care,” Hernandez says, citing “timely
appointments, great doctor services and compassionate, nonjudgmental,
medically accurate information.”

Even though she has a job, Hernandez
currently relies on her parents’ health care plan, but she says she’s
worried that once she turns 26 and is knocked off that plan she will be
left with no option, especially if there’s no Medicaid expansion.

“If they defund Planned Parenthood and
they don’t expand Medicaid, there’s pretty modest estimates of over
450,000 people being affected by this in Ohio,” she says.

She adds, “The thing that Ohioans needs
to understand and Gov. Kasich needs to understand is that the 800,000
people who go to Planned Parenthood in Ohio every year don’t go to make
an ideological or political statement. They go because it’s the only
place they have to go and it gives them top-quality care. They may not
have access to that anywhere else in their lives.”

Let’s not talk about sex, baby

When the budget bill first made it
through the Ohio House’s budget committee, it included an amendment that
would have effectively banned comprehensive sex education. Rep. Lynn
Wachtmann, a Republican from the small northwestern Ohio town of
Napoleon, successfully proposed the amendment restricting sex education.
He told reporters that the restrictions would have effectively shifted
Ohio to “abstinence-only” education in schools.

The amendment was stripped after a 76-19
vote in the Ohio House, but not after garnering national attention for
its reference to “gateway sexual activity.”

The amendment would have banned any
implicit or explicit promotion of “gateway sexual activity” in schools,
disallowed individuals or groups to distribute contraceptives on school
grounds, banned demonstrations with “devices specifically manufactured
for sexual stimulation” in classrooms and forced teachers to emphasize
adoption over abortion and teach that having kids out of wedlock could
harm “the child, the child’s parents and society.”

The rejected amendment would have created
a $5,000 fine that teachers would be subjected to if they explained the
use of condoms, birth control or other basic sex facts in a way that
promoted, implicitly or explicitly, “gateway sexual activity.” The
amendment did make some exceptions for medically correct information,
but the information had to be given in a way that would not enable or
promote “gateway sexual activity.”

For many, the phrase “gateway sexual
activity” raised more questions: What does that mean? Is it like a
feared gateway drug, only it relates to sex? Why is the government
dictating sexual activity?

The amendment defined “gateway sexual
activity” by using Ohio’s criminal code definition for “sexual contact,”
which is defined as “any touching of an erogenous zone of another,
including without limitation the thigh, genitals, buttock, pubic region,
or, if the person is a female, a breast.” In other words, “gateway
sexual activity” is practically any sexual activity.

The amendment would have allowed teachers
to share basic facts about contraceptives, such as condoms reducing the
chance of pregnancy or contracting HIV.

But if a student approached a
health teacher, said he’s having sex and wants to know how to apply a
condom or use any other form of birth control, the teacher would have
not been able to offer guidance because an answer would enable “gateway
sexual activity.”

The amendment was eventually rejected,
but it still represented the interests of the state’s conservative
warriors. Even Rep. Ron Amstutz, a Republican from Wayne County who
later pushed to get the anti-comprehensive sex education language
removed, actually voted for the amendment while the budget bill worked
through the Ohio House’s budget committee, which he chairs.

Meanwhile, Leipold of Right to Life of
Northeast Ohio says abstinence-only efforts are needed to tame a
cultural movement that’s gone too far.

“Now kids are learning that responsible
sex means that you can have sex but just use birth control,” she says.
“That’s not supposed to be the attitude. The attitude is supposed to be
that sex is for a committed relationship between a man and a woman in a
marital relationship.”

But the research on abstinence programs
has not been kind to that type of thinking. The most comprehensive
research has correlated abstinence-only education to higher rates of
teen pregnancy in comparison to comprehensive sex education programs.

A 2007 study published in the Journal of
Adolescent Health found abstinence-only programs have no impact on rates
for teenage pregnancy or vaginal intercourse, while comprehensive
programs that include birth control education reduce rates.

A 2011 study from researchers at the
University of Georgia that looked at data from 48 states concurred that
abstinence-only programs do not reduce the rate of teenage pregnancy.
The study indicated states with the lowest teenage pregnancy rates tend
to have the most comprehensive sex and HIV education programs.

Still, abstinence-only programs have
gained limited traction in some areas. In 2010, supporters of
abstinence-only programs rejoiced when a major study from a University
of Pennsylvania researcher finally supported their ideas. The study,
which tracked black middle school students over two years, found
students in an abstinence-only program had lower rates of sexual
activity than students in the comprehensive program. But the study did
not look at longer-term effects, particularly when the students reached
high school.

For Democrats, the perceived absurdity of
the amendment quickly prompted a fundraising campaign. Following the
amendment’s passage through the Ohio House’s budget committee, Ohio
Democrats sent out a fundraising email mocking the bill: “Today,
Republicans introduced a budget amendment to ban ‘gateway sexual
activity’ (whatever that is). The GOP effort would prohibit all
comprehensive sexual education from our schools, but that’s not it! If
an organization supports anything other than abstinence, they’d be
banned from classrooms. And anything from distributing birth control to
condoning pre-marital sex could carry a stiff $5,000 fine. Sometimes
Republicans’ ‘laser focus’ on job creation gets distracted.”

The fundraising campaign prompted a
response from Ohio Republicans that oddly referenced the terrorist
attack on the Boston Marathon two days earlier. In an email to CityBeat,
Ohio Republican spokesperson Matt Henderson wrote, “I mean we’re
partisan, heck, we created StopOhioJobKillers.com, but it’s downright
insulting that Ohio Democrats and Chris Redfern would rather play
politics than show respect for those in Boston whose children were
ripped apart by shrapnel less than 24 hours earlier.”

Health care? No thanks!

On top of pushing for conservative social
policies, the Ohio House budget forgoes an opportunity to provide
health insurance coverage to nearly half a million Ohioans, save the
state money over the next decade and bring health care jobs to the
state.

When Kasich proposed the first iteration
of “Jobs Budget 2.0,” the bill asked for a full expansion of the state’s
Medicaid program, but Ohio House Republicans have since walked back
that proposal to simply ask for a Medicaid waiver that would give
legislators more time to work on an expansion and perhaps carry out even
bigger reforms.

Under the Affordable Care Act
(“Obamacare”), states are financially incentivized to expand their
Medicaid programs to include anyone at or below 138 percent of the
federal poverty level, or annual income of about $15,856 for a
single-person household and $32,499 for a family of four. If a state
expands its Medicaid program, the federal government would pick up the
entire tab for the expansion for the first three years. Afterward, the
expansion would be drawn down to 90 percent over the next decade, where
it would remain.

If Ohio took up the offer, it would mean
expanding a health care program for low-income earners, impoverished
children and non-workers with disabilities that currently includes one
in six Ohioans, or 2.2 million people.

It may seem like a great deal, but state
Republicans are not convinced it’s a good plan for Ohio. It all started
with a letter from State Treasurer Josh Mandel to state legislators,
which warned Republicans of the potential financial consequences of a
Medicaid expansion: “There is no free money. While expanding Medicaid
may direct more federal dollars to Ohio in the next few years, in the
long term Ohioans will have to repay the debt that is funding federal
government spending. … If Ohio’s leaders take the bait today, I fear
that generations of Ohio taxpayers will be on the hook for the long-term
costs of expanding Medicaid.”

The fear, which has been echoed time and
time again by state Republicans, is that the federal government might
pull Medicaid funds in the future, even though there has been no
historical precedent in which the federal government failed to live up
to its Medicaid commitment since the program was signed into law in
1965.

Kasich’s proposal planned for a situation
in which the federal government pulled funding. If that happened, an
automatic trigger would have immediately halted and pulled back any
Medicaid expansion.

But that didn’t eased Republican
legislators’ concerns. Michael Dittoe, spokesperson for Speaker of the
House William Batchelder and Ohio House Republicans, says Obamacare’s
massive commitment and the rapid growth of Ohio’s Medicaid program are
unprecedented, making them potentially bigger problems for both the
state and federal government.

“(Republican House members) have a
serious doubt that the federal government is going to be able to
maintain its commitment,” Dittoe says. “If the federal government can’t
live up to their commitment that they’ve made to the state of Ohio, what
happens to the hundreds of thousands of people that are now on the
Medicaid program?”

He adds, “Given that in the last decade
the cost of Medicaid in the state has doubled, our members want to look
at reforming the program and possibly seeking alternative solutions.”

Instead of going for a full Medicaid
expansion, Dittoe says legislators want to look at how Medicaid can be
changed to insure more people at lower costs in a way that better fits
Ohio. For this, he says legislators have been looking at experiments in
other states, including Florida and Arkansas.

In Arkansas, legislators recently passed a
plan that expands coverage of low-income people through a privatization
scheme instead of a traditional Medicaid expansion. The Obama
administration has so far supported the plan as a reasonable
alternative, even though private insurance plans typically cost more
than public health plans.

Still, Dittoe admits legislators could potentially do nothing — no reform, no expansion — but he says that’s unlikely.

Distrust of the federal government is not
new to Republican politics. Republicans at all levels of government
have warned of a large federal government hindering state-based
governance. But this time, the anti-government fervor may actually cost
Ohio and its citizens money and health coverage.

A study from the Health Policy Institute
of Ohio released in January and revised in March found the Medicaid
expansion would insure 456,000 Ohioans by 2022. It would also save the
state money — about $1.8 billion over the next decade — by creating jobs
through more demand in the health care market and shifting health care
costs from Ohio to the federal government.

In other words, the Medicaid expansion
would save the state money by generating enough economic activity to
create jobs, but the budget, which, again, is called “Jobs Budget 2.0”
by supporters, is, at the very least, delaying that job-creating
expansion.

The Medicaid expansion would also come
with financial benefits for hospitals. As part of Obamacare, the federal
government is making cuts to providers around the nation. The idea was
that the provider cuts would be made up by expanded insurance coverage,
which would lead to more paying customers and less uncompensated care in
hospitals.

But that policy was built on the basis
that the Medicaid expansion would be mandatory, which the U.S. Supreme
Court altered in its 2012 decision on Obamacare. While the Supreme Court
ruling did generally uphold Obamacare and its individual mandate, it
also decided that a Medicaid expansion was too coercive because it was
effectively mandatory through a threat that the federal government would
pull all Medicaid funding if state governments didn’t decide to expand.
The Supreme Court decision made the Medicaid expansion optional,
leading to Ohio’s stalemate today.

The Ohio Hospital Association (OHA),
which has supported Obamacare since it was first challenged in court,
has been pushing state legislators to support the Medicaid expansion.
John Palmer, spokesperson for OHA, says the rejection of the Medicaid
expansion would force Ohio hospitals to endure the totality of
Obamacare’s cuts without anything to make up for them.

But he also makes a humanitarian plea for the Medicaid expansion.

“These are hard-working Ohioans that
either have some support through a part-time job or are working to kind
of get by,” Palmer says. “When it comes to health care, they just don’t
receive it. This extension would help provide a safety net for those
Ohioans from a health care standpoint.”

Palmer says Medicaid isn’t even a great
financial deal for health care providers. For every dollar in care
provided, Palmer says hospitals get 83 cents back. That may seem like a
bad deal, but it’s better than an alternative in which uninsured people
get treated and end up not paying for care at all, leaving hospitals to
foot the entire bill.

OHA was among health care providers and
others that took part in an April 11 rally in support of the Medicaid
expansion, making similar arguments to a crowd of 2,500. Kasich also
supported the rally, but it clearly wasn’t enough to convince Ohio House
Republicans to include the Medicaid expansion in their budget bill.

Moody’s, an independent credit and
research agency, recently supported the warnings from health care
providers. In a statement for its March 14 report, the agency said
either states or hospitals would face great budgetary strain if states
reject a Medicaid expansion.

“States that opt out of Medicaid
expansion will have to choose whether to compensate for the shortfalls
with their own funds or leave hospitals to absorb the costs, which will
increase rating pressure on the hospitals,” said Nicole Johnson, senior
vice president of Moody’s, in a statement. “States that choose to fund
uncompensated care costs themselves could face budgetary strain.”

The report presents a stark reality for
Ohio: If Republicans don’t take federal funds that they fear will
eventually vanish, the state government and hospitals will be forced to
foot the bill anyway to make up for Obamacare’s funding cuts.

Political endgame

For many progressive advocates, it
remains a mystery how the state government keeps coming back to
conservative social policies in a state that elected Democratic
President Barack Obama twice and handily re-elected Democratic Sen.
Sherrod Brown last year, particularly with the support of young and
women voters who are more socially liberal. But the state’s
congressional district map may have some answers.

A July 2012 study from Fair Vote found
redistricting is causing congressional districts to become more
polarized. In other words, as state officials redraw congressional maps
to benefit one party more than the other and build politically safe
Republican and Democratic seats, they’re also building districts that
are becoming increasingly polarized.

When Ohio’s Republican legislators go
back to congressional districts that were redrawn in 2011 to heavily
favor Republicans, they’re finding constituencies that reward
conservative policies and punish liberal policies and even political
moderation.

The one exception in Ohio’s legislative
process is Kasich, who has to worry about voters around the entire
state, not just polarized congressional districts. Whether that
ultimately has a political impact will be seen in 2014, when Kasich will
run for re-election.

Background on nine officials involved in the defunding of
Planned Parenthood and potential rejection of Ohio’s Medicaid expansion

State Treasurer Josh Mandel:Even though Mandel can’t legislate from the state
treasurer’s office, he began the campaign against the Medicaid expansion
with a letter to state legislators asking them to reject it.

Rep. Ron Amstutz (R-Wooster):Amstutz chairs the Ohio House Finance and Appropriations
Committee, which originally passed a budget bill banning comprehensive
sex education in Ohio. He later supported the amendment that got the
language repealed.

Rep. Lynn Wachtmann (R-Napoleon):Wachtmann has been one of the strongest advocates against
abortion in the Ohio House. He introduced the amendment that would have
banned comprehensive sex education.

Rep. William Batchelder (R-Medina):As speaker of the house, Batchelder helped pass the Ohio
House budget bill that defunds Planned Parenthood and forgoes the
Medicaid expansion.

Gov. John Kasich:The governor will have the final say on whether the Ohio
House budget passes. His position on defunding Planned Parenthood so far
is unclear, but he’s been a strong advocate for the Medicaid expansion.

Rep. Jeff McClain(R-Upper Sandusky):McClain is the vice chair of the Ohio House Finance and
Appropriations Committee, which approved a budget bill that banned
comprehensive sex education in Ohio. The rest of the Ohio House
eventually stripped the amendment.

Sen. Bill Seitz (R-Cincinnati):Seitz will help rework the Ohio House budget bill to meet the Ohio Senate’s wants and needs. In an email to CityBeat,
Seitz said he supports the funding measures that decrease money going
to Planned Parenthood and the plan to forgo the Medicaid expansion.

Sen. Keith Faber (R-Celina):As senate president, Faber will play a prominent role in
the Ohio Senate budget process. Faber has been one of the strongest
opponents of abortion rights, previously supporting the heartbeat bill,
which would have banned abortions after a heartbeat is detected.